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Case 12 Pneumonia > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is Pneumonia?

A

Signs of lower respiratory tract infection (fever/cough/phlegm/crepitations or bronchial breathing) + CXR changes

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2
Q

What is the severity scale for community acquired pneumonia (CAP)?

A

CURB-65

Confusion
Urea >7mmol/L
Respiratory rate >30
BP <90 mmHg or diastolic <60 mmHg
Age >65 years

Each feature score a point

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3
Q

What is the most common cause of CAP?

A

Streptococcus pneumoniae

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4
Q

What are common clinical features of pneumonia?

A

Cough - dry or productive, haemoptysis can occur

Breathlessness

Fever

Chest pain - pleuritic

extra-pulmonary manifestations - confusion, abdominal pain, diarrhoea and vomiting

Legionella or mycoplasma - myalgia and arthralgia

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5
Q

What are the signs of pneumonia?

A

Reduced chest expansion on effected side

Dullness to percussion

On auscultation - crepitations, bronchial breathing, increased vocal resonance

Fever, tachycardia

Reduced O2 Sats

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6
Q

How do you investigate pneumonia?

A

U and Es - AKI

Gas exchange - ABGs + SaO2

Diagnosis - CXR - looking for consolidation, FBC (WCC, CRP)

Cause - Blood culture, Sputum culture and sensitivity, Urinary antigen tests - pneumococcus and legionella, Pneumonia <60y/o –> HIV testing

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7
Q

What are the typical causes of CAP?

A

Strep pneumoniae, Haemophillius influenzae, klebisella pneumoniae, staph aureus

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8
Q

What are the atypical causes of CAP?

A

mycoplasma pneumoniae, legionella pneumophillia, chlamydia pneumoniae, chlamydia psittaci

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9
Q

What are the most common viral causes of CAP?

A

Influenza A and B

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10
Q

What are the most common fungal causes of CAP?

A

Pneumocystis jirovecii

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11
Q

What is Hospital Acquired Pneumonia?

A

It is defined as new onset of symptoms along with a compatible x-ray developing more than 48 hours after the patient’s admission to hospital

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12
Q

What is the treatment for CAP? (3)

A

Amoxicillin, clarithromycin or doxycycline

CURB65 0-1 - Amoxicillin PO

CURB 65 2 - amoxicillin + clarithromycin oral

CURB65 >3 –> Co-amoxiclav 1.2g/8h IV or cephalosporin (e.g. cefuroxime 1.5g/8h IV) AND clarithromycin 500mg/12h IV

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13
Q

What is the treatment for HAP?

A

Aminoglycoside IV + antipseudomonal penicillin IV or 3rd gen cephalosporin IV

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14
Q

What is the clinical effectiveness of the influenza vaccine?

A

60-82%

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15
Q

What is treatment for pneumonia with sepsis?

A

Pipercillin-tazobactam (Tazocin) + Clarithromycin

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16
Q

How is strep pneumoniae diagnosed?

A

postive pneumococcal antigen + Gm +VE coccus on culture

17
Q

What causes does clarithromycin cover?

A

atypical, intracellular causes

18
Q

What are common causes of HAP?

A

Gm -ve bacteria, MRSA

19
Q

What is the CURB-65 score?

A

Its a scoring system for CAP which quantifies risk of mortality

20
Q

What are the complications of pneumonia?

A

Simple para-pneumonic effusion, empyema, metastatic infection, VTE, antibiotics SEs, sepsis, abscess

21
Q

How can pneumonia be prevented?

A

Smoking cessation, adult flu and pneumococcal infection, child vaccinations

22
Q

Which organism causes bibasal pneumonia?

A

Staph Aureus

23
Q

What colour is sputum in pneumococcal pneumonia?

A

Red/rust coloured

24
Q

What are extra-pulmonary features of legionella infection?

A

diarrhoea, myalgia, arthralgia

25
Q

What is the pathophysiology of pneumonia?

A

Characterised by acute inflammation of the lung parenchyma. This is associated with cellular (neutrophil) infiltration, inflammatory exudate in the interstitium, alveolar oedema and haemorrhage. The alveolar spaces are filled with the inflammatory exudate resulting in consolidation of the alveoli.

26
Q

What are the clinical features of Staph Aureus?

A

Gm +ve coccus, more common after influenza, ICDU at risk, chronic lung pathology at risk

27
Q

What are the clinical features of mycoplasma pneumoniae?

A

Can be associated with epidemics, tend to affect younger patients, dry cough, patchy consolidation on CXR

28
Q

What are the clinical features of chlamydia pneumoniae?

A

occurs in outbreaks in family and institutions, in young adults and extremes of age

29
Q

What are the clinical features of chlamydia psittaci?

A

Associated with contact with birds, can cause hepatosplenomegaly

30
Q

What is an atypical organism?

A

Intracellular pathogens and cannot be cultured using standard methods and alternative diagnostic tools are needed. Therefore, atypical organisms need to be treated with antibiotics which get into intracellular space

31
Q

What causes most URTIs?

A

Viruses

32
Q

What is early-onset HAP?

A

Occurs within 4-5 days of admission and is usually caused by antibiotic-sensitive community organisms

33
Q

What is late onset infection?

A

(>5 days) is more likely to be caused by antibiotic-resistant hospital pathogens.

34
Q

What common organisms should be considered when dealing with a hospital acquired pneumonia?

A
  • Staphylococci (including MRSA)
  • Enterococci
  • Gram negative bacilli (such as E-Coli or pseudomonas) or a mixed flora if aspiration pneumonia is suspected
35
Q

Why does aspiration pneumonia usually involve the right lower lobe?

A

The right main bronchus is straighter from the trachea as compared to left main bronchus, which has a more oblique origin, so aspiration usually occurs in the right main bronchus

36
Q

When should patients with pneumonia be followed up after discharge from hospital?

A

Followed up after 6 weeks and an chest x-ray should be performed at that time to make sure the shadowing on chest x-ray has cleared

37
Q

When should patient feel ‘back to normal’ after pneumonia infection?

A

6 months

38
Q

When should a patient not be discharged?

A

If they’ve had two or more of the following:

  • temperature higher than 37.5°C
  • respiratory rate 24 breaths per minute or more
  • heart rate over 100 beats per minute
  • systolic blood pressure 90 mmHg or less
  • oxygen saturation under 90% on room air
  • abnormal mental status
  • inability to eat and drink without assistance

Case 12 Pneumonia (5 decks)

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